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DiagnÃsticos de enfermagem em infartados submetidos à angioplastia coronariana com STENT / Nursing diagnoses in patients with acute myocardial infarction submitted to the coronary angioplasty with STENTGlaziane da Silva Paiva 01 April 2007 (has links)
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A terapia de reperfusÃo coronariana com angioplastia coronariana transluminal percutÃnea e colocaÃÃo de stent constitui, atualmente, o tratamento preferencial ao paciente acometido por infarto agudo do miocÃrdio. No perÃodo pÃs-angioplastia, o paciente infartado exige cuidados da equipe de enfermagem peculiares devido ao comprometimento cardÃaco e dependÃncia fÃsica. A identificaÃÃo dos diagnÃsticos de enfermagem direciona as aÃÃes de enfermagem assistidas e delegadas pelo enfermeiro. O objetivo do estudo foi analisar os diagnÃsticos de enfermagem em pacientes com infarto agudo do miocÃrdio submetidos à angioplastia transluminal percutÃnea primÃria com uso de stent coronariano. Estudo transversal de natureza descritivo-exploratÃria, realizado em um hospital pÃblico de Fortaleza-Ce. A populaÃÃo constou de 51 pacientes em seu primeiro episÃdio de infarto que realizaram angioplastia com sucesso na colocaÃÃo de stent e internados nas enfermarias cardiolÃgicas. Os dados foram coletados por meio de entrevista, exame fÃsico e consulta ao prontuÃrio do paciente durante os meses de janeiro a agosto de 2006. Os resultados mostraram predominÃncia de homens, pardos, com mÃdia de idade de 54 anos e baixa escolaridade. Identificou-se maior freqÃÃncia de infarto anterior, com artÃria descendente anterior esquerda culpada pela isquemia e classificaÃÃo de killip I. Foram encontrados, em mÃdia, 11 diagnÃsticos de enfermagem, 28 caracterÃsticas definidoras, 6 fatores relacionados e 5 fatores de risco por paciente. Os diagnÃsticos de enfermagem de maior freqÃÃncia foram: Risco de infecÃÃo, DentiÃÃo prejudicada, IntolerÃncia à atividade, DÃficits no autocuidado para banho/higiene, higiene Ãntima e vestir-se/arrumar-se, PadrÃo de sono perturbado, DeambulaÃÃo prejudicada e Mobilidade fÃsica prejudicada. A variÃvel nÃmero de diagnÃsticos apresentou associaÃÃo estatisticamente significativa com os diagnÃsticos de dÃficit no autocuidado, deambulaÃÃo e mobilidade prejudicadas. Houve associaÃÃo estatisticamente significativa entre os diagnÃsticos relacionados ao autocuidado, mobilidade e locomoÃÃo, e destes com os fatores relacionados restriÃÃes de movimentos prescritas, limitaÃÃo imposta pela retirada da bainha e estado de mobilidade prejudicada. Os dados revelaram predominÃncia de fenÃmenos relacionados à ordem biolÃgica e importÃncia na identificaÃÃo dos diagnÃsticos de enfermagem na clientela especÃfica de modo a embasar um plano de atividades de enfermagem voltadas ao atendimento das necessidades fisiolÃgicas de autocuidado e dependÃncia fÃsica. / The coronary reperfusion therapy with percutaneous transluminal coronary angioplasty and stent placement constitutes, now, the preferential treatment to the patient attacked by acute myocardial infarction. In the period after to angioplasty, the patient with infarct demands peculiar cares of the nursing team due cardiac compromising and physical dependence. The identification of the nursing diagnoses addresses the actions attended and delegated by the nurse. The objective of the study was to analyze the nursing diagnoses in patients with acute myocardial infarction submitted to the primary percutaneous transluminal coronary angioplasty with use of coronary stent. Cross sectional study of descriptive-exploratory character, accomplished in a public hospital of Fortaleza-Ce. The population consisted of 51 patients in their first infarct episode that they accomplished angioplasty with success in the placement stent and interned in the cardiac infirmaries. The data were collected by means of interview, physical exam and it consults to the recordsâ patient during the months of January to August of 2006. The results showed predominance men, brown, with average of 54 year-old age and it lowers education level. It identified high frequency of previous infarct, with artery descending previous left accused by the ischemia and Killip Classification I. They were found, on the average, 11 nursing diagnoses, 28 defining characteristics, 6 related factors and 5 risk factors for patient. The nursing diagnoses of larger frequency were: Risk for infection, Altered dentition , Activity intolerance, Bathing/hygiene self-care deficit, Toileting self-care deficit, Dressing/grooming self-care deficit, Sleep pattern disturbance, Impaired walking and Impaired physical mobility. The variable number of diagnoses presented statistic association with the diagnoses self-care deficits, Impaired walking and Impaired physical mobility. There was significant association between the diagnoses related to the self-care, mobility and locomotion, and of these with the factors related prescribed restrictions of movements, limitation imposed by the retreat of the hem and state of harmed mobility. The data revealed predominance of phenomenons related to the biological order and importance in the identification of the nursing diagnoses in the specific clientele in way to base a nursing care plan of activities returned to the attendance of the physiologic needs of self-care and physical dependence.
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Avaliação seriada por ultrassom intracoronário do suporte vascular bioabsorvível com eluição de novolimus DESolveTM / Serial assessment by intracoronary ultrasound bioresorbable coronary scaffold eluting with novolimus DESolveTMGentil Barreira de Aguiar Filho 03 October 2017 (has links)
INTRODUÇÃO: Os suportes vasculares bioabsorvíveis (SVB) surgiram com a finalidade de aumentar a segurança tardia das intervenções coronárias percutâneas (ICP). Estes dispositivos liberam o fármaco antiproliferativo no local da obstrução e são absorvidos com o passar do tempo. A utilização do ultrassom intracoronário (USIC) pode ajudar na avaliação do processo de absorção deste dispositivo. OBJETIVOS: Primário: avaliar e comparar, pelo USIC, o volume e a área da luz, do vaso e do SVB imediatamente após o implante da prótese, e, tardiamente, aos 6 e 18 meses. Objetivos secundários: avaliar e comparar, pelo USIC, o volume e área da placa imediatamente após o implante da prótese, e, tardiamente, aos 6 e 18 meses e os diâmetros do vaso, lúmen e SVB após ICP e no seguimento. Percentual de estenose e perda tardia do lúmen pela angiografia no seguimento e incidência de eventos cardíacos adversos maiores (ECAM) até os 18 meses. MÉTODO: Trata-se de um estudo prospectivo, não randomizado com a inclusão de 20 pacientes que foram submetidos ao implante do SVB DESolve®. Foi realizado o USIC após o procedimento e aos 6 e 18 meses de seguimento. RESULTADOS: Dos 20 pacientes selecionados, um paciente recusou realizar o USCI aos 6 meses e dois não realizaram o exame aos 18 meses, sendo excluídos do estudo. Totalizando 17 pacientes analisados. A idade média foi de 58,59 ± 8,73 anos e 70,6% eram do sexo masculino. O quadro clínico predominante era de angina estável. A via de acesso preferencial foi a radial, todos os pacientes foram submetidos à pré e pós-dilatação e o sucesso angiográfico ocorreu em todos os casos. No seguimento, houve aumento significativo na área (6,41 ± 1,35 mm2 vs. 7,35 ± 1,53 mm2, p < 0,002), volume (101,19 ± 20,9 mm3 vs. 118,51 ± 26,6 mm3, p = 0,001) e diâmetros do dispositivo, pelo USIC, aos 6 meses quando comparado ao procedimento índice. Não houve alteração significativa nas áreas, nos volumes e nos diâmetros do vaso e lúmen, em qualquer comparação no seguimento. A perda tardia foi de 0,22 ± 0,30 mm aos 6 e de 0,33 ± 0,44 mm aos 18 meses. Não houve nenhum caso de reestenose angiográfica e trombose do dispositivo. No seguimento, não houve casos de ECAM. CONCLUSÕES: A ICP com a utilização do SVB DESolve® para o tratamento da doença arterial coronária não complexa demonstrou resultados promissores. Houve aumento do volume e área do dispositivo aos 6 meses e uma supressão eficaz da hiperplasia intimal sem ECAM no seguimento. / INTRODUCTION: The bioresorbable vascular scaffolds (BVS) emerged in order to increase late safety of percutaneous coronary interventions (PCI). These devices release the antiproliferative drug to the site of obstruction and are absorbed over time. The use of intravascular ultrasound (IVUS) can help in the evaluation of this device absorption process. OBJECTIVES: The primary endpoint was to evaluate and compare, through IVUS, the volume and the area of the lúmen, the vessel and the device immediately after its implantation, and later at 6 and 18 months. The secondary endpoints were to evaluate and compare, through IVUS, the volume and the area of the plaque immediately after its implantation, and later at 6 and 18 months and diameters of the vessel, lúmen and BVS after PCI and at follow-up. Percentage of stenosis and late lúmen loss by angiography and incidence of major adverse cardiac events (MACE) up to 18 months. METHOD: This is a prospective, non-randomized study, with the inclusion of 20 patients who underwent implantation of DESolveTM. IVUS was performed after the procedure and at 6 and 18 months of follow-up. RESULTS: Of the 20 patients selected, one patient refused to perform the USCI at 6 months and two did not undergo the exam at 18 months and were excluded from the study. In total, 17 patients were analyzed. The average age was 58.59 ± 8.73 years and 70,6% were male. The most common clinical presentation was stable angina. The preferred vascular acess was to radial, all patients underwent pre- and post-dilation and angiographic success occurred in all cases. At follow-up there was a significant increase in area (6,41 ± 1,35 mm2 vs. 7,35 ± 1,53 mm2, p < 0,002), volume (101,19 ± 20,9 mm3 vs. 118,51 ± 26,6 mm3, p = 0,001) and diameters of the device, by IVUS, at 6 months when compared to the index procedure. There was no significant change in the areas, volumes and diameters of the vessel and lúmen, in any comparison at follow-up. The late loss was 0,22 ± 0,30 mm at 6 and 0,33 ± 0,44 mm at 18 months. There were no cases of restenosis and scaffold thrombosis. During follow-up there was no case of MACE. CONCLUSIONS: PCI with the use of DESolve scaffold for the treatment of non-complex coronary artery disease has shown promising results. There was an increase in the volume and area of the device at 6 months and an effective suppression of intimal hyperplasia without MACE at follow-up.
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Avaliação tomográfica dos parâmetros anatômicos relevantes na punção renal percutânea nos decúbitos ventral e dorsalArvellos, André Noronha 26 August 2011 (has links)
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Previous issue date: 2011-08-26 / Introdução: Impulsionada pelo crescimento da endourologia, a busca de novas
técnicas para o acesso percutâneo, com intuito de tornar o procedimento ainda
menos invasivo e mais seguro, teve como marco os trabalhos de Valdivia Uría, que
propôs e descreveu primeiramente a técnica de punção do paciente em decúbito
dorsal inclinado, mostrando menor tempo de procedimento e melhora nos
parâmetros cardiorrespiratórios durante sua realização em relação à técnica clássica
em decúbito ventral, com sucesso terapêutico e morbidade semelhantes. Mesmo
após mais de 20 anos da descrição da sua técnica e com a publicação de outras
séries de casos por outros autores, a mesma não teve a difusão esperada.
Pacientes e métodos: Foi realizada análise de exames de tomografia
computadorizada de 71 pacientes através de simulações de nefrostomia percutânea
nos decúbitos dorsal e ventral, correlacionando-se os resultados com variáveis
antropométricas e quantificação da gordura abdominal no seu padrão de distribuição
nos compartimentos visceral e subcutâneo. Resultados: Não houve diferença
estatística entre o número de lesões de órgãos abdominais para os diferentes
decúbitos nas simulações realizadas no plano axial (p=0,5621). Nas simulações
oblíquas, os resultados mostraram significância estatística da diferença do decúbito
no risco de lesão, sendo o resultado desfavorável ao decúbito ventral (p=0,0295). O
órgão mais freqüentemente sob risco foi o cólon, seguido de longe pelo intestino
delgado. A avaliação indireta do risco de lesão através de medidas da distância do
cólon ao rim mostrou maior proximidade destes na posição de decúbito ventral, para
ambos os lados, de forma estatisticamente significativa. Quanto à metodologia de
análise, observou-se maior número de lesões nas simulações realizadas no plano
axial do que nas simulações oblíquas tanto no decúbito ventral (p= 0,0274) como no
dorsal (p= 0,0002). Nas simulações no plano axial, os pacientes que tiveram órgãos
lesados mostraram de forma estatisticamente significativa menores peso, índice de
massa corpórea (IMC) e quantidade de gordura visceral independente do decúbito.
No plano oblíquo, não foi observada associação estatística com tais variáveis.
Conclusão: Houve maior risco de lesão de órgãos abdominais (principalmente o
cólon) no decúbito ventral, tanto através das simulações de punção, quanto através
da análise indireta de risco através das medidas de proximidade do cólon com o rim.
A metodologia com as simulações no plano oblíquo mostrou-se mais adequada, com
resultados mais próximos das grandes séries de casos onde o procedimento foi
realizado. Em relação aos dados antropométricos e padrão de distribuição da
gordura abdominal por tomografia computadorizada (TC), os pacientes que tiveram
órgãos lesados apresentaram de forma estatisticamente significativa menores peso,
IMC e área de gordura visceral nas simulações no plano axial, para a análise
conjunta das metodologias em ambos os decúbitos e para a análise conjunta da
ocorrência independente da metodologia ou do decúbito. Na metodologia de análise
no plano oblíquo, os baixos valores de p para as variáveis peso (0,07) e IMC (0,06)
podem representar uma tendência em relação ao risco de lesão, talvez com
significância estatística limitada pelo tamanho da amostra. / Introduction: The search for less invasive and safer techniques of percutaneous
access in endourology had, as landmark, the studies undergone by Valdivia Uria,
who first proposed and described access through the inclined supine position, with
shortened procedure time and better cardiorespiratory parameters, compared with
the traditional access in the prone position, and also showing similar success and
morbidity rates. Although more than 20 years have elapsed since the first publication
of the technique, and despite publications by other authors, the technique has not
been so widely embraced as expected. Patients and methods: 71 patients
underwent simulated percutaneous nephrostomy through computed tomography
(CT), in both the supine and prone positions. The results were correlated with
anthropometric variables and quantification of abdominal fat distribution in the
visceral and subcutaneous compartments. Results: There was no statistical
difference between the number of abdominal organ injuries in the two different
positions in the axial plane (p=0.5621). In oblique simulations, the difference in the
risk of injury to abdominal organs was statistically significant between the two
positions, with more injuries happening in the prone position (p=0.0295). The colon
was the most frequently injured organ, followed by the small intestine in a distant
second. Indirect injury risk assessment by measurement of the colon-kidney distance
showed statistically significant greater proximity of these organs in the the prone
position, on both sides. Concerning the analysis methodology, there were a greater
number of injuries in the axial plane than in the oblique simulations, both in the prone
position (p=0.0274) and in the supine position (p=0.0002). In the axial plane
simulations, patients who suffered organ injuries had statistically significant lower
weight, Body Mass Index (BMI) and visceral fat amount, regardless of the position.
In the oblique plane, no such statistical association was found. Conclusion: There
was greater risk of injury to abdominal organs (mainly the colon) in the prone
position, both in puncture simulations and in indirect risk assessment of risk through
the measurement of the colon-kidney distance. Simulation in the oblique plane was
the most adequate method, as it provided results that were closer to the ones from
large case series in which the procedure was performed. Concerning the
anthropometric factors and the pattern of CT-assessed abdominal fat distribution,
patients who suffered organ injuries had statistically significant lower weight, BMI and
visceral fat amount, in the axial plane, for analysis of the two methods in both
positions and for analysis of the injuries regardless of method and position. In the
oblique plane analysis methodology the low p values for weight (0.07) and BMI (0.06)
may represent a tendency towards the injury risk, maybe with a limited statistical
significance owing to the sample size.
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Bettseitige Bohrlochtrepanation als Therapie des subakuten und chronischen Subduralhämatoms / Bedside percutaneous tapping as a therapy for subacute and chronic subudural haematomavon Dechend, Raphaela 06 December 2017 (has links)
No description available.
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IMPLANTE DE CATETER DE DIÁLISE PERITONEAL: TÉCNICA DE SELDINGER E TÉCNICA CIRÚRGICA, RESULTADOS NO HOSPITAL UNIVERSITÁRIO DE SANTA MARIA / IMPLANT OF PERITONEAL DIALYSIS CATHETER: SELDINGER TECHNIQUE AND SURGICAL TECHNIQUE, RESULTS AT HUSMPansard, Rafael Boeira 17 March 2015 (has links)
Peritoneal dialysis (PD) is a well-established modality of renal replacement
therapy, which has as a principle for its proper function the guaranteed access to the
peritoneal cavity. PD catheter implant technique should be safe, as well as provide
minimal inconvenience to the patient, agility for the service, and few complications. At
the University Hospital of Santa Maria (HUSM; Santa Maria, RS, Brazil), the
catheters were inserted by laparotomy since the 1980s. It is been desired by the
Nephrology department an alternative to facilitate the procedure, leading to greater
agility and greater autonomy of the service. This study aimed to analyze the results
obtained by professionals trained to implant peritoneal catheters with the Seldinger
technique, recently implemented, and those obtained with the standard surgical
technique. The samples were obtained from medical records of patients with endstage
chronic kidney disease at the Nephrology department of HUSM with peritoneal
dialysis indication (n=104). The demographic profile of the patients was evaluated, as
well as the presence of infection and / or bleeding in the surgical wound, the first
infusion and the 30-day functionality of the catheters, and the survival rate one and
two years after implant. Data for each peritoneal catheter insertion mode were
expressed as frequencies and then compared by chi-square, Fisher exact or Mann
Whitey tests, with a 5% significance level. The profile of the two groups had similar
characteristics in relation to gender, age, history of diabetes mellitus and arterial
hypertension. The functionality of the implant at first infusion was also similar for both
groups (83.9%for Seldinger vs. 79% for surgery). When evaluated the functionality in
30 days, the Seldinger technique demonstrated a higher success rate (76.7%) than
the surgical technique (43.6%) (P-value=0,002). Regarding the presence of infection
and / or bleeding in the outside wound, the percentage was similar for both groups
(14.8% for Seldinger vs. 16.9% for surgical). The survival rate of the catheters at 1
and 2 years was also similar for both groups (37% and 14.8% for Seldinger, 23.7%
and 20.6% for surgery, respectively). Given these results, it can be concluded that
the implant of peritoneal catheters by Seldinger technique is a qualified alternative
that allows greater agility to the service since it is an ambulatory procedure, can be
performed by nephrologists and involves less patient management; having similar
functionality to surgical implant according to the experience reported at HUSM. / A diálise peritoneal (DP) é uma modalidade bem estabelecida de terapia renal
substitutiva, que tem como princípio para seu bom funcionamento a garantia de
acesso à cavidade peritoneal. A técnica de implante do cateter de DP deve ser
segura, além de proporcionar o mínimo de inconveniência para o paciente, agilidade
para o serviço, e poucas complicações. No Hospital Universitário de Santa Maria
(HUSM; Santa Maria, RS, Brasil) os cateteres foram implantados por laparotomia
desde a década de 1980. É almejada pelo Serviço de Nefrologia uma alternativa que
facilite o procedimento, levando a maior agilidade e autonomia do Serviço. O
presente trabalho se propôs a analisar os resultados obtidos, por profissionais
treinados para implante de cateter peritoneal com a técnica percutânea de
Seldinger, recentemente implantada, e os resultados obtidos com a técnica
padrão, a cirúrgica. As amostras foram obtidas de dados dos prontuários de
pacientes entre os pacientes com insuficiência renal crônica terminal do Serviço de
Nefrologia do HUSM com indicação de diálise peritoneal (n=104). Foi avaliado o
perfil demográfico dos pacientes, assim como a presença de infecção e/ou
sangramento na ferida operatória, a funcionalidade do cateter na primeira infusão e
após30dias, além da taxa de sobrevivência em um e dois anos após o implante. Os
dados obtidos em cada modalidade de implante de cateter peritoneal foram
expressos em frequências e posteriormente comparados pelos testes Qui-Quadrado,
Exato de Fischer ou Mann Whitey, com um nível de significância de 5%. O perfil dos
dois grupos apresentou características semelhantes em relação ao gênero, idade,
ocorrência de diabetes mellitus e hipertensão arterial. A funcionalidade do implante,
na primeira infusão, também foi semelhante para os dois grupos (83,9% para
Seldinger, 79% para cirúrgico). Quando avaliada a funcionalidade em 30 dias, a
técnica de Seldinger mostrou um percentual de sucesso (76,7%) maior que a técnica
cirúrgica (43,6%) (P-valor=0,002). Com relação à presença de infecção e/ou
sangramento no orifício de saída, o percentual foi semelhante para os dois grupos
(14,8% para Seldinger, 16,9% para cirúrgico). A taxa de sobrevivência dos cateteres
em 1 e 2 anos também foi semelhante para os dois grupos (37% e 14,8% para
Seldinger, 23,7% e 20,6% para cirúrgico, respectivamente). Diante dos resultados,
pode-se concluir que o implante de cateter peritoneal pela técnica percutânea de
Seldinger é uma alternativa qualificada que permite maior agilidade ao serviço já que
o procedimento é ambulatorial, pode ser realizado por nefrologistas e implica em
menor manejo do paciente; apresentando funcionalidade semelhante ao implante
cirúrgico conforme a experiência relatada no HUSM.
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Magnetic resonance imaging-guided percutaneous abdominal interventionsKariniemi, J. (Juho) 11 October 2011 (has links)
Abstract
Magnetic resonance imaging (MRI) provides high contrast and spatial resolution images in arbitrarily chosen plane without ionizing radiation. These valuable features make it an attractive technique for guiding percutaneous interventional procedures. The purpose of this study was to develop percutaneous abdominal diagnostic and therapeutic procedures in MRI surroundings by evaluating the feasibility, safety and clinical results of specific interventional procedures.
The safety and accuracy of MRI-guided abdominal biopsy was evaluated by performing MRI-guided biopsy on 31 patients who were not amenable for an ultrasound-guided biopsy. The locations of the lesions were liver, pancreas, lymph node, retroperitoneal mass, adrenal gland, and spleen. Fine-needle aspiration (FNA) biopsy was performed on all 31 patients; 18 patients underwent both FNA biopsy and cutting needle core biopsy. The sensitivity, specificity and accuracy of FNA and core biopsies were 71, 100 and 81%, and 90, 100 and 94%, respectively. No immediate or late complications occurred.
The feasibility and safety of MRI-guided percutaneous drainage of pancreatic fluid collections was assessed by performing ten percutaneous drainages under MRI-guidance. Five of the patients had symptomatic pseudocysts and five had pancreatic abscesses. All procedures were performed with an MRI-compatible drainage kit using the Seldinger technique. All drainage catheters could be successfully placed into the pancreatic fluid collections under MRI-guidance with a mean procedure time of 44 minutes. No immediate complications occurred.
The feasibility and safety of MRI-guided percutaneous nephrostomy was evaluated by performing eight nephrostomies with MRI-guidance. The degree of the dilatation of the renal collecting system varied from minimal to severe. All procedures were performed solely under MRI guidance with MRI-compatible instruments. Seven out of eight nephrostomies were successfully performed under MRI guidance; nephrostomy catheter could not be placed in a nondilated system. The mean procedure time was 26 minutes. No major complications occurred during the procedures or follow-up.
The safety and effectiveness of MRI-guided percutaneous laser ablation for the treatment of small renal cell carcinoma (RCC) was assessed by treating eight patients with ten tumors with percutaneous MRI-guided laser ablation. All tumors were biopsy-proven RCCs. One to four laser fibers were used per tumor and the tumors were ablated under near real-time MRI control. All but one tumor were successfully ablated in one session. One complication, a myocardial infarction, occurred; all other patients tolerated the procedure well. No local recurrence was discovered during the follow-up with a mean time of 20 months. / Tiivistelmä
Magneettikuvauksella elimistön kudoksista ja sairauksista saadaan tarkkaa tietoa missä tahansa kuvaussuunnassa ilman ionisoivaa säteilyä. Näiden ominaisuuksiensa takia magneettikuvaus on houkutteleva menetelmä myös kuvantaohjattujen perkutaanisten toimenpiteiden tekemiseen. Tämän tutkimuksen tavoitteena oli kehittää perkutaanisia vatsan magneettiohjattuja toimenpiteitä. Tämä tehtiin arvioimalla magneettikuvauksen soveltuvuutta, turvallisuutta ja kliinisiä tuloksia erilaisten diagnostisten ja terapeuttisten toimenpiteiden ohjaamisessa.
Magneettiohjattujen vatsan neulanäytteiden turvallisuutta ja tarkkuutta arvioitiin 31 potilaalla, joille ei voitu tehdä ultraääniohjattua biopsiaa. Näytteitä otettiin maksasta, haimasta, imusolmukkeista, retroperitoneaalisista kasvaimista, lisämunuaisista ja pernasta. Kaikilta 31 potilaalta otettiin solunäyte, 18 potilaalta otettiin lisäksi kudosnäyte. Solunäytteiden sensitiivisyys oli 71 %, spesifisyys 100 % ja tarkkuus 90 %; kudosnäytteissä vastaavat luvut olivat 90 %, 100 % ja 94 %. Neulanäytteiden otosta ei aiheutunut yhtään komplikaatiota.
Magneettiohjauksen soveltuvuutta ja turvallisuutta haiman nestekertymien perkutaanisessa dreneerauksessa arvioitiin kymmenellä potilaalla, joista puolella oli oireileva haiman pseudokysta ja puolella haiman absessi. Kaikki kanavoinnit tehtiin Seldingerin tekniikalla käyttäen magneettiyhteensopivia toimenpidevälineitä. Kaikkien nestekertymien dreneeraus magneettiohjatusti onnistui ilman välittömiä komplikaatioita ja keskimäärin toimenpiteeseen kului aikaa 44 minuuttia.
Magneettiohjauksen soveltuvuutta ja turvallisuutta punktionefrostomian tekemiseen tutkittiin kahdeksalla potilaalla, joilla hydronefroosin aste vaihteli vähäisestä vaikeaan. Kaikki toimenpiteet tehtiin magneettiyhteensopivilla toimenpidevälineillä. Magneettiohjatut punktionefrostomiat onnistuivat lukuun ottamatta yhtä potilasta, jolla munuaispikareissa oli vähäistä laajentumaa. Keskimääräinen toimenpideaika oli 26 minuuttia eikä yhtään hoitoa vaativaa komplikaatiota tapahtunut.
Magneettiohjatun perkutaanisen munuaissyövän laserpolton turvallisuutta ja tehokkuutta tutkittiin kahdeksalla potilaalla, joilla oli yhteensä kymmenen kasvainta. Kaikki kasvaimet olivat biopsialla varmennettuja munuaissyöpiä. Laserpoltot tehtiin lähes reaaliaikaisessa magneettikuvauskontrollissa käyttäen yhdestä neljään laserkuitua jokaista kasvainta kohden. Yhtä lukuun ottamatta kaikkien kasvainten poltto onnistui yhdellä hoitokerralla. Yhdellä potilaalla hoitoa komplisoi sydäninfarkti, mutta muut sietivät hoidon hyvin. Potilaita seurattiin hoidon jälkeen keskimäärin 20 kuukautta eikä seurannassa todettu yhtään taudin uusiutumaa.
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A mixed methods study investigating re-presentation, symptom attribution and psychological health in primary percutaneous coronary intervention patientsIles-Smith, Heather January 2012 (has links)
Introduction: Following ST-elevation myocardial infarction (STEMI) and treatment with Primary Percutaneous Coronary Intervention (PPCI), some patients re-present with potential ischaemic heart disease (IHD) symptoms. Symptoms may be related to cardiac ischaemia, reduced psychological health or a comorbid condition, which share similar symptoms and may lead patients to seek help via acute services. The purpose of the study was to investigate the proportion of PPCI patients who re-presented to acute services due to potential IHD symptoms within 6 months of STEMI, and to explore associated factors. Methods: An explanatory mixed methods study was conducted. Quantitative data were collected at baseline and 6 months from consecutive patients attending two centres in Manchester. Variables were carefully considered based on a conceptual model for re-presentation. These included potential IHD symptom and psychological health assessments using self-report measures: the Seattle Angina Questionnaire (SAQ) and the Hospital and Anxiety and Depression Scale (HADS). Physiological health was measured using the Global Registry of Acute Coronary Events (GRACE) and the Charleson Comorbidity Index (CCI) at baseline. At 6 months re-presentation data were collected using patient records, a telephone interview and a self-report diary card. The experiences of some who re-presented (purposeful sampling) were explored through semi-structured interviews conducted at least 6 months following PPCI. Framework analysis was adopted to analyse data. Results: 202 PPCI patients returned baseline questionnaires [mean age 59.7 years (SD 13.9), 75.7% male]; 38 (18.8%; 95% CI 14.0% to 24.8%) participants re-presented due to potential IHD symptoms at 6 months; 16 (42.1%) re-presented due to a cardiac event and 22 (57.9%) did not receive a diagnosis. At both baseline and 6 months, mean HADS anxiety scores were higher for the re-presentation group compared to the non-representation group (baseline 9.5 vs 7.1, p=0.006; 6 months 9.4 vs 6.0, p<0.001). Angina symptoms were stable and infrequent at both time points for the groups. Multivariate regression modelling with the inclusion of predictors HADS anxiety, SAQ angina stability, SAQ angina frequency, GRACE and CCI, determined HADS anxiety as a predictor of re-presentation with an adjusted odds ratio of 1.12 (95% CI 1.03 to 1.22, p=0.008). The qualitative interviews with re-presenters included 25 participants (14 men, 27-79 years). Four themes were identified: fear of experiencing a further heart attack, uncertainty and inability to determine cause of symptoms, insufficient opportunity to validate self-construction of illness and difficulty adapting to life after a heart attack. Conclusion: Elevated levels of anxiety at baseline were predictive of re-presentation with potential IHD symptoms at 6 months. Factors such as shock at experiencing a heart attack, hypervigilance of symptoms and difficulty with symptom attribution appeared to play a role in raised anxiety levels for the re-presentation group. Findings suggested that changes are needed to cardiac rehabilitation and post-STEMI follow-up to address educational needs and psychological issues and changes in STEMI treatment.
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Elektroakupunktur som behandlingsmetod vid ländryggssmärta : En litteraturstudie / Electroacupuncture as treatment for low back pain : A literature reviewFilin, Tex, Pierce, Victor January 2017 (has links)
Bakgrund: Akupunktur är en gammal behandlingsmetod, beräknad ungefär 4100 år gammal och kommer från Kina. Elektroakupunktur är en något nyare behandlingsmetod där man för ström mellan nålarna. Denna behandlingsmetod används främst av fysioterapeuter. Behandlingarna som fysioterapeuten utför kräver ett vetenskapligt stöd, därför finns ett behov att granska den litteratur som behandlingsmetoden grundas på. Inom forskning och verksamhet använder man olika namn för denna metod, både “electroacupuncture” och “percutaneouselectricalnervestimulation” (PENS). Ryggsmärta är ett vanligt problem bland världens befolkning, det är beräknat att upptill 70% av befolkningen kommer någon gång i sitt liv uppleva ryggssmärta. Det är även beräknat att vara den vanligaste smärtförekomsten. Om elektroakupunktur fungerar mot ländryggssmärta kan terapeuter använda denna behandlingsmetod. Syfte: Syftet med denna studie var att undersöka vilket vetenskapligt stöd det finns för elektroakupunktur som behandlingsmetod vid ländryggssmärta. Metod: En systematisk sökning utfördes i databaserna CinAHL, PubMed, PEDro, Scopus och Web of Science angående elektroakupunktur och ländryggssmärta. Sökorden som användes var “electroacupuncture”, “lowback pain ”, “percuteaneous electricalnervestimulation” och “randomized controlled trial”. Resultat: Sammanlagt 15 RCT – studier inkluderades i denna studie. Sammanlagt 11 av 15 studier fann signifikanta skillnader i resultat. 8 studier behandlade kronisk ländryggssmärta, 4 behandlade diskogena besvär och resterande 3 behandlade andra ryggdiagnoser. Elektroakupunktur har visat ge en smärtlindring vid ländryggssmärta. Konklusion: Samtliga inkluderade studier fann smärtlindring av behandlingen, dock visade inte alla signifikanta skillnader. Det finns även metodologiska brister i den befintliga litteraturen vilket innebär att bör se resultaten kritiskt. Mer forskning inom området behövs.
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Percutaneous sensitization is limited by in situ inhibition of cutaneous dendritic cell migration via skin-resident regulatory T cells / 経皮感作は皮膚制御性T細胞による樹状細胞遊走の阻害を介して制限されているHanakawa, Sho 25 November 2019 (has links)
京都大学 / 0048 / 新制・課程博士 / 博士(医科学) / 甲第22122号 / 医科博第107号 / 新制||医科||7(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 生田 宏一, 教授 濵﨑 洋子, 教授 杉田 昌彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM
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Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation / 冠動脈ステント留置術後1年超を経た心房細動患者において抗凝固薬と抗血小板薬の併用療法に対する抗凝固薬単独療法の妥当性を検証したオープンラベルランダム化比較試験Nakano, Yukiko 23 March 2021 (has links)
京都大学 / 新制・課程博士 / 博士(医学) / 甲第23057号 / 医博第4684号 / 新制||医||1048(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森田 智視, 教授 湊谷 謙司, 教授 川上 浩司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM
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